NHSCB head seeks "mature" relationship with ministers

Professor Malcolm Grant, newly-appointed chair of the NHS Commissioning Board (NHSCB), has told the House of Commons Health Committee that he is seeking a "mature" relationship with government ministers.

"A mature and open relationship will be needed between ministers and the Board, with clear expectations about processes and behaviours," Prof Grant told the Committee, at a pre-appointment hearing held this week to consider Health Secretary Andrew Lansley's proposal to appoint him to chair the new Board.

Asked by the MPs what he considered would be the "optimum relationship" between the Board and ministers, Prof Grant replied that the NHSCB will be "an independent body operating at arm's length from government. Its accountability relationship with Parliament and ministers is clear - the Board will be held to account for delivering the requirements set out in the mandate through its work with the commissioning and broader NHS system."

Ministers will remain accountable to Parliament and to the public for all aspects of the NHS, but will be at arm's length from detailed operational decision-making, he added.

The MPs also asked Prof Grant what he felt the "optimum relationship" would be between the Board and the new local clinical commissioning groups (CCGs). He replied that the Board's key role will be "to support the CCGs to be as successful as possible in commissioning high-quality care for their patients." This will require it to use a range of levers, including development, progress monitoring, performance assessment and intervention in the event of failure, he said, adding: "the Board will need to use all of these levers effectively to support all CCGs to realise their potential and thereby ensure delivery of improved outcomes."

He also emphasised the need to strike the right balance between supporting and guiding CCGs on the delivery of the national mandate and creating enough local freedom for the benefits of clinical commissioning to be realised.

"This will require a mature and open two-way relationship which recognises that some CCGs will need more support from the Board then others," Prof Grant told the MPs.

But, asked if he felt the Board would need to establish a formal intermediate tier between itself and the CCGs, he responded by pointing out that it is still too early to be definitive about the "detailed design" of the Board.

"While there will be no additional statutory tier between the Board at national level and CCGs at local level, inevitably the Board will need to carry out many of its functions across distinct geographical areas," he said. Current transitional proposals are for the Board's "initial sub-national footprint" to reflect the four Strategic Health Authority (SHA) clusters and 50 Primary Care Trust (PCT) clusters which are operating at present.

The MPs also asked Prof Grant what he felt was the best way of reconciling the fact that the optimum size of a commissioning unit for the purposes of GP engagement is significantly smaller than the optimum size for the purposes of driving system change.

He replied: "there is no ideal population size for commissioning all the different types of health care. As a result, CCGs are likely to need to join together to commission services where a larger population size is needed. Clinical senates and networks will also play a role in supporting commissioning across large areas. The most specialised services will be commissioned by the Board itself, reflecting the need for a flexible commissioning system."

Prof Grant told the panel that an early priority for him will be to support recruitment of the Board's senior leadership, and then the initial development of its systems and culture. "The early focus of the role will also include establishing key relationships, developing the Board of the organisation effectively and guiding the development of strategy and purpose," he added.

Following the hearing, the Health Committee members reported that they were “pleased to endorse Prof Malcolm Grant's candidacy for the post."